Most of the scientific research discussed in this report was derived from a 1997 New York Academy of Sciences conference on "Cocaine: Effects on the Developing Brain," as well as from investigations conducted by researchers at RAND Drug Policy Research Center. Although the problems of children exposed to cocaine in utero are not as severe as was once feared, some cocaine-exposed infants do suffer subtle neurological damage and later have learning and behavioral problems. A number of research studies had reported that children prenatally exposed to cocaine experience reduced fetal growth (e.g., small head size), lower IQ levels, and neurobehavioral symptoms (e.g., attention difficulties). On entering school, many cocaine-exposed children have difficulty in regulating behaviors (e.g., they exhibit inattentiveness and impulsiveness), and this has an adverse effect on academic success and on adaptability and functioning later in life. Primary prevention -- avoiding cocaine and other drug use before and during pregnancy -- remains the best approach to preventing exposure. It is important that women who are pregnant or who are at risk for pregnancy be educated about the potential dangers to the fetus from all forms and levels of prenatal exposure to harmful substances. Secondary prevention involves identifying pregnant women who use drugs and minimizing their drug use. Secondary prevention strategies aimed at health-care providers should include education and training in substance-abuse detection techniques, education about State and institutional protocols for reporting prenatal substance exposure, and involvement of physicians in designing and implementing the protocols. Tertiary prevention involves reducing the adverse consequences of substance exposure in children who were exposed in utero. More research is required to enable health-care providers to identify at-risk children, to understand the nature of their deficits, and to intervene on their behalf. This report discusses three major areas where more research is needed: the specific action of cocaine on the developing brain and its manifestations in infants and children; the role of environmental and other factors; and community and educational interventions. 51 references